Request for Advising

Blinn College SBDC

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For all of the following questions, please answer regarding the existing or planned business for your advising request.

First Name
Last Name
Zip Code	Enter your 5 digit Zip Code. If you don't have one or don't know your zip code, enter 00000

Business Name	Leave blank if you do not have a name chosen or the business name is the same as your name.
Position	Your position or title related to this business
Address	Your physical street address (number and street) of the business. If a home based business, or the business has not started yet, use your home address.
Address Line 2	Optional. Use if you need additional address postal information like apt, floor, suite, etc., or a PO box.
City
State

Please enter contact information regarding this business so that we may contact you if necessary

Primary Phone	The best phone number (with area code) to reach you during our standard business hours. Include extension if necessary.
Primary Phone Type	Type of the primary phone above
Secondary Phone	A secondary phone number to contact you, if we cannot reach you at the primary number.
Secondary Phone Type	Type of the secondary phone above

Web Site	Web site URL for the business
Business Description	Brief three to five word description of the business

Please answer the following demographic questions about yourself.

Race	Asian Black or African American North African Middle Eastern Native American/Alaska Native Native Hawaiian/Pacific Islander White Prefer not to say Check any that apply
Hispanic Ethnicity
Gender
LGBTQ
Person with Disability	Do you consider yourself a person with a disability
Military Status
Branch of Service
What is your preferred language?

Business Status

Existing Business (in business operations for one or more years)

Check the above box ONLY if you have been operating a business for a minimum of one (1) year.
DO NOT CHECK the above box if you are in the planning or start-up stages for a new business.

Since this business has started, please enter the following information.

Year Started	Year this business started
Month Started	Month this business started
Business Type	Primary category of business
Female Ownership %	% Enter the percent female ownership for this business.
Business Online	Yes If business is conducted online
Home Based Business	Yes If business is home based
8(a) Certified	Yes If you are currently 8(a) certified.

Business Organization

Legal entity of the business

Employees FT

Current Number of Full Time Employees

Employees PT

Current Number of Part Time Employees

Annual Sales $

Annual Sales $ for the most recent full business year

Annual P/L $

Annual Profit/Loss $ for the most recent full business year

Are you currently exporting

Yes

Export Employees	Current Number of Total Export Related Employees
Export Sales $	Export Related Sales for most recent full business year
Export Countries	Countries you are currently exporting to. Start typing the name of the country and a list will appear to choose from. You may select more than one.

How did you hear about us?	Choose the best category above.
Details for how you heard about us	Please provide bank name; or add the person or resource name of the How You Heard About Us category above.
Assistance Requested	Business Accounting-Budget Business Plan Buy-Sell a Business Cash Flow Management Customer Relations Cybersecurity eCommerce Financing/Capital Franchising Government Contracting Human Resources/Employees International Trade Legal Issues Managing Business Marketing/Sales Start-up Assistance Tax Planning Technology/Computers Check all the kinds of assistance that you seek
Do you request a specific advisor? If YES, insert advisor name.
Briefly describe the specific assistance you are requesting

Please read each statement below carefully to show you understand our responsibilities as an SBDC and your rights as our client.

We will send you two surveys via email: an Initial Survey after your first meeting and an Annual Survey, so you can evaluate your satisfaction with our advisory services. If we spend a significant amount of time working with you, we will send you a confidential Impact Survey about two years after we start working with you. The survey will determine if we helped you start your business, increase sales, create new jobs, and/or obtain financing. If we continue to work with you, we will send you the survey each year.
We do not charge for advisory services, and we will not solicit or accept payment of any kind including goods or services, gifts, loans, rewards, equity in a business, compensation or other monetary remuneration, promise of future employment, or favor or service in return for the advisory services we provide.
We cannot invest in the business of any client.
We will not recommend the purchase of goods or services from sources in which we have a direct or indirect interest.
We do not make loans nor influence loan decisions, although we can assist you with determining your financial requirements and preparing and submitting a loan application.
We keep what you tell us confidential to the extent allowable under Federal and Texas State law.
We will not use anything you tell us to benefit the SBDC or any of our staff, nor will we use what you tell us to the detriment of any of our clients.
We provide advisory services to clients in all fields and industries, and your advisor may work with other clients whose businesses are similar to yours and even in direct competition with yours. Your advisor may also have outside employment or interests in a business similar to yours or in competition with yours. Please ask your advisor for a copy of their resume.
While employed by the SBDC and for six months subsequent to the term of employment, your advisor should not accept private business advising engagements from any persons seeking advising services from the UH SBDC Network.
We will maintain the highest standards of professional conduct and make every effort to provide prompt, courteous and quality services within the time frame requested; however, we do not make any warranties or guarantees regarding these services.

Client Rights and SBDC Responsibilities

I agree to these rights and responsibilities.

Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.

I request no-cost business advisory services from the Texas Gulf Coast SBDC Network, which is a resource partner of the U.S. Small Business Administration.

I understand that checking “YES” in the box below is NOT a requirement to receive business advisory services from the SBDC. The SBDC cannot by law share your contact information. Do NOT check the box below if you do not want your contact information shared with the SBA.

I permit SBA or its agent the use of my name and address for SBA surveys and information mailings regarding SBA products and services. I understand that any information disclosed will be held in strict confidence.
I consent to the usage of my name, photograph and/or testimonials in either print or electronic publications, as well as on social media platforms, for the purpose of publicity, news, scholastic, and/or development purposes.

I agree to participate when I am asked to complete surveys designed to evaluate the business advisory services.

I self-certify that neither I nor my company are currently suspended by a Federal agency.

I certify that my business has not been, is not currently, nor will it at any time be operated or otherwise used in any manner that is in violation of criminal law, nor has it assisted, nor is it currently assisting, nor will it at any time assist another individual or entity in any manner that violates criminal law. I agree to release, indemnify, and hold harmless, the University of Houston System, the University of Houston, The Texas Gulf Coast Small Business Development Center Network and its host organizations, as well as each of the above entity’s respective board members, officers, directors, employees, authorized representatives, advisors, and other personnel (”Releasees”) from and against any and all liability that may arise from the actions (negligent or otherwise) by me, my business, or its employees, as well as against any and all claims or causes of action that may be brought against the Releasees by me, my business, my employees, or any third party, or that may be brought against me, my business, or its employees, by a third party.

Please enter your full name, indicating your acceptance of the above terms.

Full Name:

Date: 4/24/2024 9:32:09 PM

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